Primary lung cancer and pleural effusion—diagnostic and therapeutic approach

Abstract

The presence of a malignant pleural effusion automatically classifies patients to advanced cancer stage and it is associated with significant mortality and morbidity. Suspected and confirmed malignant pleural effusions due to lung cancer constitute a common yet serious clinical problem encountered in acute health care settings and they are related to poor quality of life and prolonged hospital stay. This article highlights the current diagnostic and treatment approaches. It emphasizes in the appropriateness and sensitivity of various imaging modalities used to assess malignant pleural effusions with focus in the minimum amount of pleural fluid detected with each imaging technique. In the case of smaller pleural effusions this offers clinicians a better insight regarding the magnitude of the problem. Thoracentesis, cytology and pathology acquisition constitute the next steps in the diagnostic pathway. Pleural aspiration is the recommended approach preferably with ultrasound guidance and to pursue histological confirmation medical thoracoscopy is equivalent to surgical thoracoscopy in terms of diagnostic yield and superior in terms of length of stay and complications. The review also provides a concise overview in the use of therapeutic drainage and pleurodesis and it highlights the extended use of indwelling pleural catheters in the management of malignant pleural effusions secondary to lung cancer.